Smoking and binge-drinking among adolescents, Ontario, Canada: Does the school neighbourhood matter?

This study examines whether access to alcohol and tobacco around the school relates to higher or lower odds of cigarette smoking and binge-drinking among Ontario high school students. The 2013 Ontario Student Drug Use and Health Survey provides data on self-reported smoking and drinking, individual covariates and subjective socio-economic status for 6142 students (grades 9-12) in Ontario, Canada. Locations of schools were geocoded and 1.6km network buffers defined the school neighbourhoods. Multi-level logistic regression examines individual and school neighbourhood factors with smoking and binge drinking as the dependent variable. Higher density of retail outlets increased the odds of smoking, but not the odds of binge-drinking. Older age, lower SES and being male increased the odds of smoking; while older age and being male also increased the odds of binge-drinking. Lower SES and higher population density decreased the odds of binge-drinking. Proximity to tobacco and alcohol outlets was not significant. Findings showed that a greater number of outlets in the school neighbourhood is significantly associated with higher odds of smoking, but not binge-drinking. School neighbourhood access to tobacco outlets should be considered when formulating policy interventions to reduce smoking for adolescents.

Looking beyond cigarettes: Are Ontario adolescents with asthma less likely to smoke e-cigarettes, marijuana, waterpipes or tobacco cigarettes?

OBJECTIVES: The purpose of this paper is to examine whether high school students in Ontario with asthma smoke cigarettes, waterpipes, marijuana or e-cigarettes more or less than those without asthma. METHODS: The 2013 Ontario Student Drug Use and Health Survey provides self-report data on tobacco cigarettes, waterpipes, marijuana and e-cigarette smoking and asthma rates from 109 high schools in Ontario, Canada. Individual and social characteristics were also collected. Multiple binary logistic regression models measures the association with the various types of smoking in relation to asthma. RESULTS: Adolescents with asthma have higher odds of smoking e-cigarettes or smoking any type including either cigarettes, waterpipes, marijuana or e-cigarettes. Respondents of lower socio-economic status had a higher odds of smoking marijuana or any type. Boys were more likely to smoke waterpipes, e-cigarettes or any type, while students in higher grades had a higher odds of smoking cigarettes, waterpipes, marijuana or any type. CONCLUSIONS: Results from this study suggest that adolescents with asthma have a higher odds of smoking e-cigarettes than those without asthma, but no relationship was found for cigarettes, waterpipes or marijuana. Findings present some new challenges as technology changes how adolescents can smoke. Public health campaigns should target adolescents, especially those with asthma, to raise their awareness of the risks of all types of smoking including e-cigarettes.

The search for healthy schools: A multilevel latent class analysis of schools and their students.

The objective of this study was to establish and investigate a taxonomy of school health among high school students in Ontario, Canada. Data analyzed were based on 3358 9th-12th graders attending 103 high schools who participated in the 2011 Ontario Student Drug Use and Health Survey. Based on 10 health-related indicators, multilevel latent class analysis was used to extract 4 student-level latent classes and 3 school-level latent classes. Unhealthy schools (19% of schools) had the lowest proportion of healthy students (39%) and the highest proportion of substance-using (31%) and unhealthy (18%) students. Healthy schools (66%) contained the highest proportion of healthy students (56%) and smaller proportions of substance-using (22%) and unhealthy students (8%). Distressed schools (15%) were similar to healthy schools in terms of the proportions of healthy and unhealthy students. Distressed schools, however, were characterized by having the largest proportion of distressed students (35%) and the lowest proportion of substance-using students (4%). Meaningful categories of schools with respect to healthy environments can be identified and these categories could be used for focusing interventions and evaluating school health programs.

Ten-year trends in overweight/obesity among Ontario middle and high school students and their use in establishing baseline measures for government reduction targets.

OBJECTIVES: Public health concern about increasing levels of child/youth overweight and obesity has resulted in initiatives to address this issue. In 2012, the Ontario Ministry of Health and Long-Term Care (MOHLTC) established a target to reduce childhood obesity by 20% within five years. In this paper, we examine trends and establish baseline levels of overweight/obesity to assess the impacts of population-level interventions. METHODS: We analyzed 10 years (2003-2013) of data accumulated from six cycles of the Ontario Student Drug Use and Health Survey using logistic regression to assess trends in the prevalence of overweight/obesity among middle and high school students. The 2013 data are used to begin monitoring progress toward achieving the MOHLTC target. RESULTS: From 2003 through 2013, the prevalence of overweight/obesity among middle school students in the province remained stable overall and among all subgroups except 7th-grade females, who showed a significant linear decline. Among high school students, the prevalence of overweight/obesity showed a significant linear increase and an increase among 11th graders, females, and 10th- and 11th-grade females specifically. The prevalence remained stable but elevated among 9th- and 12th-grade females as well as among males in all grades. In 2013 (baseline for the MOHLTC target), 25.1% of students in grades 7-12 were overweight or obese, implying a presumed 2018 target of 20.1%. CONCLUSION: Ten-year trends in overweight/obesity indicate stability among males and significant linear increases in some female subgroups. Also, baseline data (2013) will facilitate the monitoring of future interventions aimed at achieving the 2018 MOHLTC target.

Multiple health-risk behaviour and psychological distress in adolescence.

OBJECTIVE: To examine the prevalence and correlates of psychological distress in a school-based sample of Canadian adolescents. METHOD: Self-reported data of demographics, weight status, physical activity, screen-time, diet, substance use, and psychological distress were derived from a representative sample of 2935 students in grades 9 to 12 (M(age) = 15.9 years) from the 2009 Ontario Student Drug Use and Health Survey. RESULTS: Overall prevalence of psychological distress was 35.1%. Significant associations were shown between psychological distress and the following: being female, tobacco use, not meeting physical activity and screen-time recommendations, and inadequate consumption of breakfast and vegetables. CONCLUSIONS: These findings highlight the need for targeting greater physical health promotion for adolescents at risk of mental health problems.

Adolescents' attitudes toward wheelchair users: a provincial survey.

The study aims were to examine (i) adolescents' attitudes towards family members who use a wheelchair in relation to other health problems and conditions, and (ii) the association between perceived wheelchair stigma and socio-demographic factors. Data were based on surveys from 2790 seventh to 12th grade students derived from the 2007 cycle of the Ontario Student Drug Use and Health Survey. Stigmatized attitudes towards a family member who required the use of a wheelchair (5.5%) were lower than those attitudes towards a family member who was addicted to drugs (68.3%), alcohol (54.9%), or gambling (53.7%), or who had mental illness (25.9%), and similar to those attitudes for a family member with asthma (2.2%). Grade level was the only significant negative correlate of the perceived wheelchair stigma. The perceived wheelchair stigma among the adolescents may not be a significant barrier towards community integration for wheelchair users.

Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis.

BACKGROUND: Alcohol exposure is one of the major risk factors for global burden of disease, but atrial fibrillation (AF) had not yet been included in these estimates. The purpose of this contribution was to examine the dose­response relationship between alcohol consumption and AF and to explore potential causal pathways. DESIGN AND METHODS: Systematic literature review and meta-analyses. RESULTS: Overall, a consistent dose­response relationship between the amount of alcohol consumed daily and the probability of the onset of AF was found. Women consuming 24, 60 and 120 g of alcohol daily had relative risks of 1.07 [95%confidence interval (CI): 1.04­1.10], 1.42 (95% CI: 1.23­1.64) and 2.02 (95% CI: 1.60­2.97), respectively, relative to nondrinkers. Among men, the corresponding relative risks were 1.08 (95% CI: 1.04­1.11), 1.44 (95% CI: 1.23­1.69) and 2.09(95% CI: 1.52­2.86). Based on the categorical analyses, we could not exclude the existence of a threshold (three drinks a day for men and two drinks a day for women). Several pathogenic mechanisms for the development of AF in alcohol users were identified. CONCLUSION: Epidemiological criteria for causality were met to conclude a causal impact of alcohol consumption on the onset of AF with a monotonic dose­response relationship. However, the impact of light drinking is not clear.

Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis.

AIMS: To analyze the dose-response relationship between average daily alcohol consumption and the risk of hypertension via systematic review and meta-analysis. DESIGN: A computer-assisted search was completed for 10 databases, followed by hand searches of relevant articles. Only studies with longitudinal design, quantitative measurement of alcohol consumption and biological measurement of outcome were included. Dose-response relationships were assessed by determining the best-fitting model via first- and second-degree fractional polynomials. Various tests for heterogeneity and publication bias were conducted. FINDINGS: A total of 12 cohort studies were identified from the literature from the United States, Japan and Korea. A linear dose-response relationship with a relative risk of 1.57 at 50 g pure alcohol per day and 2.47 at 100 g per day was seen for men. Among women, the meta-analysis indicated a more modest protective effect than reported previously: a significant protective effect was reported for consumption at or below about 5 g per day, after which a linear dose-response relationship was found with a relative risk of 1.81 at 50 g per day and of 2.81 at an average daily consumption of 100 g pure alcohol per day. Among men, Asian populations had higher risks than non-Asian populations. CONCLUSIONS: The risk for hypertension increases linearly with alcohol consumption, so limiting alcohol intake should be advised for both men and women.

Alcohol as a risk factor for pancreatitis. A systematic review and meta-analysis.

CONTEXT: Epidemiologic studies have suggested an association between alcohol consumption and pancreatitis, although the exact dose-response relationship is unknown. It also remains uncertain whether a threshold effect exists. OBJECTIVE: To conduct a systematic review and meta-analysis of epidemiologic studies on the association between alcohol consumption and the risk of pancreatitis. METHODS: We searched Ovid MEDLINE, EMBASE, CINAHL, Web of Science, ETOH and AIM. Studies were included if they reported quantifiable information on risk and related confidence intervals with respect to at least three different levels of alcohol intake. RESULTS: Six studies, including 146,517 individuals with 1,671 cases of pancreatitis, met the inclusion criteria. We found a monotonic and approximately exponential dose-response relationship between average volume of alcohol consumption and pancreatitis. However, in a categorical analysis the lower drinking categories were not significantly elevated, with an apparent threshold of 4 drinks daily. CONCLUSIONS: As the available evidence also indicates that the relationship is biologically plausible, these results support the existence of a link between alcohol consumption and the risk of pancreatitis.

School disconnectedness: identifying adolescents at risk in Ontario, Canada.

BACKGROUND: There is strong theoretical and empirical support for school connectedness as an important element of healthy youth development. The primary objective of this study was to replicate previous research identifying factors differentiating youth who do not feel connected to their schools in a sample of adolescents in Ontario, Canada. A secondary objective was to extend this work by assessing whether physical activity was an additional health behavior that differentiated youth who feel connected to their schools from those who do not. METHODS: Data for this study were based on questionnaires from 2243 grade 7 to grade 12 students derived from the 2001 cycle of the Ontario Student Drug Use Survey. Logistic regression analysis was used to examine associations between physical activity, other health risk factors, and school disconnectedness. RESULTS: The odds of feeling disconnected from their schools were substantially greater for female students who perceived their health or academic performance to be poor, engaged in no vigorous physical activity, reported 3 or more physician visits during the past year, and had low extracurricular involvement. None of the sociodemographic factors or substance use measures was significantly associated with school disconnectedness for any students. CONCLUSIONS: Our results highlight sex differences in how school disconnectedness is related to health-compromising behaviors such as physical inactivity. Further research is required to examine how boys and girls perceive, interpret, and internalize the school climate. Increasing school connectedness should be a consideration for academic administrators and health-promotion advocates.

The decline in physical activity among adolescent students: a cross-national comparison.

BACKGROUND: The decline in physical activity during adolescence is a key public health concern. This comparative study assesses whether the age-related decline in physical activity among high school students occurs similarly in the United States (U.S.) and Ontario, whether the decline in physical activity is steady throughout the age range, or whether any declines are age-specific. METHODS: Data are based on self-reports of 9th- to 12th-graders derived from the 2001 Youth Risk Behavior Survey (n=13,503) and the 2001 Ontario Student Drug Use Survey (n=1322). Physical activity is measured by the number of days of vigorous physical activity during the past 7 days. RESULTS: In both samples, there was a dominant and steady decline in physical activity between ages 14 and 18 years. The number of activity days was higher in the U.S. than in Ontario holding constant age and sex. However, a significant sample-by-age interaction showed that the decline in the percentage of U.S. students reporting 3 or more physical activity days was greater than it was in Ontario. CONCLUSIONS: While the pattern of decline was shown to be similar, the decline was stronger among US adolescents. Future research should examine additional factors influencing the decline in activity and the optimal timing of programs to reduce the decline.

The relationship between vigorous physical activity and juvenile delinquency: a mediating role for self-esteem?

Many policy-related reviews of the potential social value of sport and physical activity list the prevention of juvenile delinquency. We examined the relationships among vigorous physical activity, self-esteem, and delinquent behavior among adolescents in a large cross-sectional survey of Ontario adolescents. Data are based on questionnaires from 3,796 students (range 11-20 years) derived from the 2005 Ontario Student Drug Use Survey. Negative binominal regression methods were used to estimate both additive and interactive models predicting delinquent behavior. Vigorous physical activity was positively associated with delinquent behavior; however, this pattern of association was observed only among male adolescents. There was no evidence of a mediating role for self-esteem. Our findings suggest that physical activity is not the solution for reducing juvenile delinquency.

Relationship of vigorous physical activity to psychologic distress among adolescents.

This article examines the relationship between vigorous physical activity and psychologic distress (by using the General Health Questionnaire-12) among a sample of 2,104 adolescents. Multiple regression analysis revealed a differential relationship between physical activity and dimensions of the General Health Questionnaire-12. Specifically, vigorous physical activity was related significantly to problems with social functioning but not to depression or anxiety.

Trends in vigorous physical activity participation among Ontario adolescents, 1997-2001.

OBJECTIVE: This paper examines trends in vigorous physical activity participation among students enrolled in grades 7, 9, 11 and 13 in Ontario between 1997 and 2001. Patterns in participation by gender and grade level are also described. METHODS: Data were derived from the Ontario Student Drug Use Survey for 1997, 1999, and 2001. Three outcomes of vigorous physical activity were included in self-report questionnaires completed by more than 5,000 students over a three-year period. They responded to the survey in classroom groups during school time. Estimates were weighted and variance and statistical tests have been corrected for the complex sample design. RESULTS: Comparisons between 1997 and 2001 indicated that, overall, patterns of vigorous physical activity remained stable. However, there were significant declines in vigorous physical activity participation by females and 11th grade students between 1997 and 2001. INTERPRETATION: The trends for females and 11th graders are disturbing, since they indicate that the normal gender and age differences in vigorous physical activity participation, found in numerous previous studies, are compounded by declining levels over time for these groups.